Paralytic Lagophthalmos Treatments (CPB 0366, reviewed 2026-05-22)
Aetna has updated Clinical Policy Bulletin 0366 (reviewed 2026-05-22) establishing clear medical necessity criteria for paralytic lagophthalmos treatments. Gold-weight/platinum-weight eyelid implants and palpebral springs are now covered only when specific selection criteria are met (delayed facial nerve recovery, exposed cornea, failed conservative treatment). Multiple procedures including muscle transposition, neuroplastic surgery, and autologous spacing grafts are covered for chronic severe cases with no spontaneous recovery likelihood. Botulinum toxin, cerclage sling, hyaluronic acid, and lipofilling remain experimental/unproven. Billing teams must immediately implement prior authorization requirements and ensure correct coding per the expanded covered procedure list.